Obstetrics

Postpartum Care

Congratulations on the birth of your new baby! We have enjoyed being a part of your pregnancy. As with pregnancy, the postpartum period brings significant physical and emotional changes, and recovery from childbirth typically takes 6-8 weeks. We hope this information proves useful in your transition to motherhood, but if you have unanswered questions, please do not hesitate to call.First Week

Attend to your personal needs and the needs of your newborn, remembering that you are as important as your new baby.

Rest is a very important part of recovery postpartum, sleep when your baby sleeps to help avoid fatigue.

If possible, have someone else responsible for household chores while you tend to your new baby.

As a rule of thumb, we suggest you not lift anything heavier than your baby in his/her carrier for at least the first week or two.

Try not to feel obligated to entertain friends and family members during the initial postpartum period, as this will only serve to drain your energy.

Try to limit strenuous activity and heavy lifting until after your six week postpartum evaluation.

Second Week:

Increase activities gradually.

Driving is allowed when you are no longer fatigued and have not taken narcotic medications for at least 2-3 days.

Get out of the house regularly.

Continue to rest when possible. Fatigue can often bring on or aggravate postpartum blues or depression.

Perineal Care/Hemorrhoids

It is important to keep the perineum as clean and dry as possible to hasten healing and minimize discomfort.

Soaking in a shallow bath, or using a sitz bath, is helpful in cleansing and decreasing discomfort.

Vaginal delivery may be traumatic to the pelvic floor, and a woman’s body may require 6 or more weeks to heal. Do not place anything in your vagina for the first six weeks (no tampons, no douches, and no intercourse).

Hemorrhoids are common during pregnancy and may even worsen after delivery. Over the counter hemorrhoid products may be helpful. An over the counter stool softener taken daily, as well as increasing the amount of daily water intake, will also help lessen discomfort.

Bathing

Showering daily will help make you feel better as you recover. Regardless of whether you had a vaginal delivery or a cesarean section, avoid deep tub baths for at least 4 weeks postpartum.

Vaginal Bleeding

Vaginal bleeding, called lochia, occurs as a result of delivery, and may last for 4-6 weeks.

Lochia typically starts as bright red blood, and becomes lighter as time goes by. While this discharge continues, we recommend use of sanitary pads, not tampons, for protection.

Your first menstrual period may return approximately 4-10 weeks after delivery. If you are breastfeeding, you may not have regular monthly periods. The return of normal menstrual cycles varies from person to person, and from pregnancy to pregnancy.

If you are soaking greater than, or equal to, a sanitary pad every hour, please call your provider. If you have sutures due to a laceration or episiotomy, these will dissolve as your body heals.

Constipation

Constipation is a fairly common problem during the immediate postpartum period.

Make sure to increase fluid intake and dietary fiber.

Whole grains, fresh fruits and vegetables are good sources of natural fiber.

Walking can also aid in good digestion and circulation.

A daily over the counter stool softener and/or any over the counter non-stimulant laxative may be needed if dietary remedies are not helpful.

Breast Care and Breastfeeding

Wear a well-fitting maternity bra.

Soap may cause your nipples to become dry and cracked, so be sure to clean nipples with plain warm water.

Leave nipples open to air dry after each breastfeeding when possible.

Drink at least 6-8 glasses of water daily.

By the time an infant is one week old, he or she will be nursing at least fifteen minutes on each breast at each feeding. Begin nursing on the breast on which the baby finished nursing during the previous feeding.

You may have increased vaginal bleeding and uterine cramping both during and after nursing, this will lessen with time.

Warm, steeped tea bags may be applied as a natural remedy for nipple soreness or pain. If lanolin use is desired for sore or cracked nipples, be sure that the nipple is completely dry before applying.

If using lanolin, it is not necessary to wash the nipple prior to breastfeeding.

Should your breasts become engorged, ice packs on top of the breasts and under the arms may help, as well as over the counter medication such as Ibuprofen. If engorgement occurs, it may be helpful to hand express or pump a small amount of breast milk before attempting to latch your baby.

If you notice a scaly redness, extreme soreness, pain during nursing, flu-like symptoms or a fever, these may all be symptoms of a breast infection and you should call your provider for further instructions.

Bottle feeding

Wear snug fitting sports bra at all times.

Avoid nipple stimulation, and also try to avoid hot showers as both may stimulate more breast milk production.

If breasts become engorged, apply ice packs to breasts for 15-20 minutes at a time, and if possible take an over the counter anti-inflammatory/pain medication such as Ibuprofen.

Engorgement usually only lasts a couple of days.

There is NOT medication available to aid in decreasing breast milk supply.

Cesarean Section

Having a cesarean section usually requires a longer recovery time. It is advisable to try to return to normal activities with a few restrictions.

Avoid heavy lifting, strenuous exercise and cleaning/vacuuming.

Driving may be resumed when you are no longer taking pain medications and are able to brake or shift without discomfort.

It is okay to walk up and down stairs in a limited fashion.

Keep your incision clean and dry with plain soap and water. It is not necessary to apply any sort of creams, ointments or gels to the incision during healing.

Your stitches will heal and absorb on their own by your six week check up.

Pregnancy is not advised for at least six months to a year following a cesarean section birth.

Your incision is essentially maintenance free. The incision is, however, a weak spot until it has completely healed.

Following are some signs of complications and you should contact your provider:

Severe pain at the incision site.

Swelling and redness of the incision site.

Bleeding or foul smelling discharge from the incision.

Fever of greater than 100.4 taken orally.

Postpartum Blues/Depression
Many women experience a somewhat depressed or “down” feeling after their baby is born. This depressed feeling is influenced by the sudden change in your hormone levels. Being tired and fatigued will contribute to this feeling; and this is another reason to make sure you are getting as much rest as possible. If the “blues” hit you, get up and do something active, keeping your mind and body occupied until the feeling passes. Remember that this is a normal part of the postpartum period for some women. It does not usually last for a very long time and is usually mild. Should these feelings persist or if they seem overwhelming to you, please contact your provider.

Diet

Continue to eat a healthy, balanced diet as you did when you were pregnant. Include lean meats, eggs, vegetables, milk, fruits, juices and whole grains.

Continue taking your prenatal vitamins until your postpartum visit or as long as you are nursing.

Nursing mothers need additional calories and protein to promote the growth of the baby and to maintain your energy. You may add two dairy servings, one vegetable, one protein and one fruit to the diet you used for pregnancy.

Drink at least 6-8 glasses of water per day.

Sexual Activity/Contraception

Sexual relations may be resumed when you no longer have any pinkish discharge, usually six weeks after delivery.

Sexual intercourse may be uncomfortable at first but should not be painful. You may need a water-soluble lubricant such as K-Y Jelly, particularly if you are breast feeding.

Because of hormonal changes associated with childbirth, we do not recommend the use of hormonal contraception for the first six weeks.

Don’t forget…..breast feeding is not a contraceptive. Ovulation may still occur, resulting in pregnancy.

Exercise

For the first few weeks, you may want to limit your physical activity to walking.

As your body heals, you can begin to add more strenuous activity, working towards a full exercise program approximately 4-6 weeks after delivery.

If you had a cesarean section, returning to a full exercise program is not recommended for 6-8 weeks after delivery.

When to Call the Office

If you have chills or fever over 100.4.

If you have increased vaginal bleeding, saturating more than one pad in one hour.

A Word from our Patients

My visit was great! & my past visit have all been great.Kristy helped me even with me being a bit stressed & in a hurry because I had to be seen & my job is super strict. Her urgency to get me seen was phenomenal. I even got to see Heather, she’s awesome & amazing. She helped deliver my baby girl a year ago. My whole family loves her and Dr Sheshadri. We actually can’t wait to get pregnant again hahaha. Everyone treats you with respect and always makes sure your okay & answers whatever questions you have before you leave. Even leaving a message for the nurses,they get back to you so quickly. This practice really makes you feel taken care of. We appreciate you all! – Erika Hooks

My experience with the TP4W staff has been top of the line. They helped me through three pregnancies and coached me through every step of the way. Eternally thankful I chose TP4W. – Britney

TP4W have such amazing doctors, midwives and nurses. I cannot say enough about Dr. Grana and the rest of the staff for all the help, advice, guidance and medical care they provided me with all of my kids. She made me feel safe and calm through both c-sections. My routine care and pregnancy care have always been top notch and I would recommend them to anyone looking for an OBGYN. – Brooke

Thank you all so much for taking such good care of me through both of my pregnancies and births, especially my latest one on 10/29! most of yall know how nervous I was from having gone through a lot (to say the least) with my first in 2016. You all made me feel so comfortable and at ease before, during and after. And going through a touch year with my dad, you guys always asked how he was doing at every appointment, which was so thoughtful and beyond your job description. I know that you all see many women go through what i did each and every day and deliver many babies and perform many c-sections. But I hope you know how special Ruby’s delivery was to me. You all have amazing jobs! I cannot thank you all enough. Merry Christmas!

Love, Lucy

I have been going to TP4W since 2010/11 and could not be happier.

The staff, nurses, midwives, and doctors are all amazing. I have 2 sons, both delivered via cesarean by Dr. V. Every visit and every provider did everything in their power to give me the birth experience I wanted, and also ensure that myself and my babies were safe and healthy. Dr. V even did everything in his power to help me avoid my first c-section and VBAC with the second, but that turned out to be out of his hands and he was the absolute best surgeon. With my two pregnancies, I experienced a few scares and some unusual circumstances that would be too long and too private to write in a review, but every single hurdle was handled with grace, honesty, and professionalism. I am so thankful for the recommendation from a friend to come to this office. I can’t imagine ever going to another practice.

TP4W is amazing and I am so very thankful I found them 9 years ago!! Amazing partnership between midwives and doctors, sweet nurses and front end staff, and relaxing environment. I literally recommend them to all my friends! I look forward to my appointments and feel like I’m going to catch up with old friends.

I’ve always had wonderful experiences at TP4W. Everyone is friendly, knowledgeable, and thorough in their care. April delivered my son and I can’t say enough wonderful things about her. She is patient and compassionate. I had the best labor and delivery experience thanks to her. I do and will continue to recommend them to my friends and family!

TP4W is amazing and I am so very thankful I found them 9 years ago!! Amazing partnership between midwives and doctors, sweet nurses and front end staff, and relaxing environment. I literally recommend them to all my friends! I look forward to my appointments and feel like I’m going to catch up with old friends.

I have been seeing Dr. Grana for just about 4 years now and I must admit that she has been the very best OB I have ever had! She is so personable, friendly, and all around caring about her patients. I’ve never had any issues with the staff, the office is very clean, and if Dr. Grana is running behind, they let me know ahead of time. I highly recommend Dr. Grana and this office to anyone!

I was referred here by my family doctor. I had found out I was pregnant with my first child later last year and had the most difficult time scheduling an appointment at my last OB/GYN Doctor. I was on the verge of tears because I didn’t know what my next steps were and thank goodness I was referred to Triangle Physicians for Women. The service is amazing every appointment I’ve had and they are so organized and have made me feel so comfortable. I have to thank them for making this pregnancy so much smoother and less stressful than it would have been had I stayed with my previous doctor. I highly recommend this place!